Wellness Model: It’s More Than Weight Loss
By Stephanie Yamkovenko
Last month, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a review of health promotion programs for people with serious mental illness. The review looked at programs that used lifestyle interventions, as opposed to medication, aimed at reducing obesity and improving fitness.
Health promotion programs are important because people with serious mental illness are at risk of premature death due to untreated preventable chronic illnesses such as obesity, diabetes, and cardiovascular disease. In addition, 42% of adults with serious mental illness are obese.1
This news is no surprise to Catana Brown, PhD, OTR/L, whose wellness program and research study was one of the more than 20 programs that SAMHSA reviewed. Brown said she had been working with people with serious mental illness in community-based settings when a study came out that found that people with schizophrenia generally die 25 years younger than the general population.2 “It was a huge wake up call to mental health providers,” she says. “Where I was working, I was seeing it happen. We were seeing people in their 30s die of heart disease. It was just really shocking.”
The SAMHSA review found that some lifestyle interventions achieve weight loss for individuals with serious mental illness, but not all programs were successful. SAMSHA identified several program characteristics that facilitated greater success, including lasting longer than 3 months, combining education and activity, and incorporating both nutrition and exercise.
An Occupational Therapy-Based Health Promotion Program
Brown’s 2006 study, which she developed with a nurse and a dietician, met these characteristics. “Some of the things that we thought made it unique were that it addressed both exercise and nutrition,” says Brown. “It was also one of the few research studies that targeted people who were living in the community.” Despite the difficulties of not being able to control diet and activity—which is much easier when participants are patients at an inpatient unit—Brown and her colleagues believed it would be more realistic to help people in their community.
Brown’s program also incorporated psychiatric rehabilitation principles that emphasized goal setting and looking at more than just social support but also the kinds of support that people with serious mental illness, who often have limited resources would need, such as low-cost cooking supplies and budget friendly but healthy grocery items.
Participants in the program attended weekly group meetings and had an overall nutrition and physical activity goal. During each session participants created weekly goals and then participated in an activity to increase goal retention. For example, during a dining out session participants learned how to use a fast food nutrition guide, and then the group went to a fast food restaurant and practiced ordering and eating a meal that met their diet plan. At the end of the program, the participants lost on average 6 pounds and had a significant reduction in abdominal circumference.3
Occupational therapy can play an important role in helping people lose weight and choose health-promoting activities. “We help people engage in everyday lives, and we really encourage them to explore all of the things that they might do on a regular basis that improves their overall state of wellness,” says Virginia Stoffel, PhD, OT, BCMH, FAOTA, AOTA's vice president. Whether that is taking a walk with a friend, learning how to cook a healthy meal, or learning how to shop at farmer’s markets on a budget, occupational therapy practitioners can promote wellness for people with mental illness.
“In terms of weight loss, many activities that you have to do are instrumental activities of daily living like cooking, shopping, and trying to create habits that are healthier,” says Brown. “We’re able to look at the cognitive impairments that are significant in people with serious mental illness and then adapt the program instruction to help them be able to take in the information and apply it in their real lives. Also, many of them have faced a lot of failures in their lives and may not have much self-efficacy in terms of believing that they can be successful, so we help people have small successes along the way so that they believe that they can then make larger changes.”
The Wellness Model
Occupational therapy practitioners working with weight loss and health promotion are working in the wellness model, which is a conscious and deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyle, according to Margaret Swarbrick, PhD, OTR, CPRP.
“The wellness model is a perfect fit with recovery and with people being able to live full and meaningful lives in their greater state of health,” says Stoffel.
The U.S. health care system has both a wellness model and a medical model. The medical model focuses more on “fixing people” by reducing symptoms. “The wellness model is a different way to view and see people,” says Swarbrick. “The medical model is short term, the wellness model has the goal of creating meaning and purpose in people’s lives so they can heal and get better.”
The wellness model does not simply focus on physical health such as weight loss, but incorporates eight dimensions—physical, spiritual, social, intellectual, emotional, occupational, environmental, and financial.4 Swarbrick notes that it is not a case of the medical model versus the wellness model. “The medical model is the prevailing model, but an important role for occupational therapy is to keep them both in balance,” she says.
Occupational Therapy in the Wellness Model
“For most of us in occupational therapy the wellness model is a familiar place,” says Stoffel. “We have always focused our efforts on helping people be as engaged in everyday life as possible to impact their state of health and wellness. I think we need to get better at helping people be more self-determining—to take responsibility for their everyday health and acting on that.”
Occupational therapy practitioners can use the wellness model to better focus on prevention, promote recovery in mental health, and help create health promotion programs. “I encourage all practitioners to remember their roots,” says Swarbrick. “The wellness model is not just for mental health, it can also be used in the school setting, the rehab setting—it can inform all areas of practice by having a holistic approach being a lens to inform intervention.”
It can be difficult for occupational therapy practitioners to use the wellness model in mental health because occupational therapy is not as well recognized in this practice area as it could be. “This is why we’re sponsoring a bill in Congress and had a congressional briefing about the role of occupational therapy in mental health,” says Stoffel (read more about the briefing here). “My hope is that the bill and advocacy will open doors."
Even with the challenges, Brown says that the obesity epidemic for people with serious mental illness has a reached a level of awareness that has caused many mental health centers to be interested in providing weight loss and wellness programs. “It’s a big area where occupational therapy practitioners can go to a mental health center and offer to help develop this programming.”
Stephanie Yamkovenko is AOTA’s staff writer.
1. SAMHSA-HRSA Center for Integrated Health Solutions (2012). Research review of health promotion programs for people with serious mental illness. Retrieved from http://www.integration.samhsa.gov/health-wellness/wellnesswhitepaper
2. Colton, C. W. & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3(2), 1–14.
3. Brown, C., Goetz, J., Van Sciver, A., Sullivan, D., & Hamera, E. (2006). A psychiatric rehabilitation approach to weight loss. Psychiatric Rehabilitation Journal 29(4), 267–273.
4. Swarbrick, M. (2012, March 2). Wellness and aging. Words of Wellness Newsletter 5(9), 3–4.